Growth Hormone Deficiency in Children and Adolescents with Cerebral Palsy: Relation to Gross Motor Function and Degree of Spasticity

Abstract

Children with Cerebral Palsy (CP) often have poor linear growth during childhood with short final height. Thus, we aimed to assess serum growth hormone (GH), insulin like growth factor-1 (IGF-1) and insulin like growth factor binding protein-3 (IGFBP-3) levels among CP patients and their relation to each of gross motor function and degree of spasticity. Fifty CP children and adolescents were studied in comparison to 50 healthy age-, sex- and pubertal stage-matched children and adolescents. All subjects were subjected to clinical evaluation, Intelligence Quotient (IQ) assessment and measurement of serum GH, IGF-1 and IGFBP-3. All auxological and hormonal parameters were significantly lower among cases. Fifty two% of cases were GH-deficient and 62% had reduced IGF-land IGFBP-3 levels. Gross Motor Function Measure- 88 (GMFM-88) score correlated negatively with each of basal (r = -0.71, p = 0.02) and peak stimulated GH (r =-0.88, p = <0.001); IGF-1 (r = -0.64, p = 0.04) and IGFBP-3 (r = -0.69, p = 0.031). There were significant negative correlations between the degree of spasticity assessed by Modified Ashworth Scale and each of basal (r = -0.61, p = 0.032) and peak stimulated GH (r = -0.78, p = 0.01); IGF-1 (r = -0.65, p = 0.041) and IGFBP-3 (r = -0.62, p = 0.035). Growth Hormone Deficiency (GHD) is prevalent in children with CP and could be one of the causes of their short stature.

Growth characteristics in cerebral palsy subtypes: a comparative assessment

“…Children with gastrostomy tubes are more likely to acquire excess body fat and become obese, increasing the risk of comorbidities and decreasing life expectancy . An important point is that patients with CP may have a variety of issues influencing their growth patterns, such as immobility, high energy requirements due to spasticity, and psychosocial deprivation . Many children with CP have comorbidities such as an endocrine disease, which may further influence growth patterns, and newer studies point to abnormalities in growth hormone and insulin‐like growth factor 1 …”

“…One of the most important factors for healthy growth and development in children is nutritional status, which has been extensively studied . Small stature or other comorbidities may also affect growth, and the patient may be nutritionally healthy .…”

“…Cerebral palsy (CP) is a fairly common disorder, having an estimated prevalence of 2/1000 in the general population. 1 Nutritional problems frequently accompany this disorder, and patients tend to be either underweight or overweight compared with the general population. 2 Studies have demonstrated growth and nutrition problems in up to onethird of children with CP.…”

“…2,4,14 An important point is that patients with CP may have a variety of issues influencing their growth patterns, such as immobility, high energy requirements due to spasticity, and psychosocial deprivation. 1,5 Many children with CP have comorbidities such as an endocrine disease, which may further influence growth patterns, and newer studies point to abnormalities in growth hormone and insulin-like growth factor 1. 1,2,5,16 One of the most important factors for healthy growth and development in children is nutritional status, which has been extensively studied.…”

“…1,5 Many children with CP have comorbidities such as an endocrine disease, which may further influence growth patterns, and newer studies point to abnormalities in growth hormone and insulin-like growth factor 1. 1,2,5,16 One of the most important factors for healthy growth and development in children is nutritional status, which has been extensively studied. 1 Small stature or other comorbidities may also affect growth, and the patient may be nutritionally healthy.…”